The purpose of this longitudinal research is compare the factors that influence physicians' perspectives on their patients and medical practice at three critical periods in their professional development: ending residency, beginning career and established career. This continuing study will re-interview in person a cohort of twenty-six physicians who were first interviewed fifteen years ago at the end of their graduate training in internal medicine and then again five years later in their early career stage. It aims to examine how myriad changes in health care over the last decade have affected their practice style and setting, relationship with patients, and satisfactions and strains. This rare in-depth look at the professional lives and world of practicing physicians will provide some insight into the relationship between macro conditions and micro processes. There are almost no qualitative studies that have followed a group of physicians as they cross critical thresholds in order to scrutinize the acquisition of, and changes in, professional attitudes and behavior. Areas for exploration include: retrospective evaluation of their medical education, concurrent assessment of present circumstances, and prospective views of their own and the medical profession's future. Have their perspectives on their training and practice shifted as professional role, organizational setting and location, financial reimbursement, and patient demographics and diseases have changed? What are current and projected sources of stress and satisfaction? This work will contribute to sociological theory an increased understanding about the permanent and situational nature of professional socialization; it will contribute to health policy development a more realistic view of the impact on patient care of current and proposed programs to increase access to, and lower costs of, health care; and it will provide a better understanding of methodology appropriate to study physician attitudes and behavior. It addresses several priorities of the AHCPR since most of the physicians--both the generalists and specialists--are engaged in primary care and are located in small city, suburban and rural settings.